Revenue Cyle Specialist (50953)

**JOB TITLE:** Revenue Cycle Specialist **DEPARTMENT**: Finance **POSITION SUMMARY** The Revenue Cycle Specialist is responsible for managing the revenue cycle processes to ensure timely, accurate, and compliant reimbursement for hospice services, with a primary focus on Medicare Part A billing and collections. This position oversees claims submission, payment posting, accounts receivable follow-up, denial management, and appeals while ensuring compliance with Centers for Medicare & Medicaid Services (CMS) regulations and organizational policies. **WORKING RELATIONSHIPS** **REPORTS TO**: Controller **SUPERVISES**: None **INTERPERSONAL RELATIONSHIPS**: All comments, actions and behaviors have a direct effect on the public’s perception of Hospice Austin. Interactions with patients, family members, physicians, referral sources, visitors, co-workers, etc. must be in a manner that is courteous, respectful, cooperative and professional. This behavior should promote an atmosphere of teamwork and positive relations. **ESSENTIAL FUNCTIONS** - Manage the complete Medicare Part A revenue cycle, including notice of election processing, billing, payment posting, accounts receivable follow-up, and reimbursement reconciliation. - File Notices of Election (NOEs/81A) timely and accurately, review the Medicare Common Working File (CWF), and verify Medicare eligibility, certification periods, benefit days, and primary payer status. - Coordinate monthly billing activities with Nursing, Clinical, and Administrative staff to ensure accurate and timely billing for all payers, with emphasis on Medicare Part A reimbursement. - Perform pre-billing quality assurance reviews using established month-end accounts receivable checklists to ensure billing accuracy and compliance. - Generate, review, and submit primary and secondary claims for Medicare Part A and other payers in accordance with CMS billing guidelines. - Monitor claim status, research claim edits and rejections, resolve billing issues, and resubmit corrected claims to ensure timely reimbursement. - Utilize Direct Data Entry (DDE), Medicare systems, clearinghouses, and other payer portals to research claim status and resolve outstanding accounts receivable. - Prepare and process claim corrections, retroactive billing adjustments, reopenings, reconsiderations, and appeals as necessary. - Run retroactive change reports and generate or adjust claims based on changes affecting reimbursement. - Post Medicare payments, contractual adjustments, and remittance advice (ERA/EOB) accurately within the patient accounting system, including hospice per diem and consulting physician payments. - Process consulting physician invoices and ensure accurate billing and payment reconciliation throughout the month. - Monitor accounts receivable aging reports, investigate outstanding balances, and perform timely follow-up to maximize collections and reduce days in accounts receivable. - Identify, investigate, and resolve denied, rejected, underpaid, or unpaid claims while documenting all account activity. - Follow up on all services that have not been billed to ensure complete and timely claim submission. - Bill charity care accounts in accordance with organizational policies and processes, approve charity write-offs, and bad debt adjustments. - Verify patient insurance eligibility, benefits, and Medicare entitlement and ensure all required documentation supports medical necessity and billing requirements. - Ensure compliance with CMS regulations, Medicare Administrative Contractor (MAC) requirements, HIPAA, and organizational policies. - Maintain current knowledge of Medicare Part A regulations, hospice billing requirements, reimbursement methodologies, and industry best practices. - Monitor revenue cycle key performance indicators (KPIs), identify reimbursement trends, and recommend process improvements to enhance operational efficiency and reduce denials. - Maintain complete and accurate patient financial records a…